Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

AIM: To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV).

METHODS: A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible non-invasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni- and multivariate approaches.

RESULTS: Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (+/- SD) was 47.5 (+/- 15.9). Portal vein diameter (13.88 +/- 2.42 vs 12.00 +/- 1.69, P < 0.0005) and liver vascular index (8.31 +/- 2.72 vs 17.8 +/- 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 +/- 1.48 vs 13.24 +/- 2.55, P < 0.05 and 6.45 +/- 2.78 vs 10.96 +/- 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 +/- 3.66 vs 20.25 +/- 5.05, P < 0.0005), congestion index (CI) (0.11 +/- 0.03 vs 0.06 +/- 0.03, P < 0.0005), portal hypertensive index (2.62 +/- 0.79 vs 1.33 +/- 0.53, P < 0.0005), and hepatic (0.73 +/- 0.07 vs 0.66 +/- 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 +/- 0.06 vs 0.62 +/- 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV).

CONCLUSION: Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.